GUEST COLUMN: A little help can keep seniors out of nursing homes and save taxpayers money

Wednesday

Sep 11, 2013 at 12:01 AMSep 11, 2013 at 12:05 AM

It's no secret: Most people, given a choice, would not move to a nursing home. Surveys have shown that 89 percent of Americans 50 and older want to live in their own homes as long as they can.

By Jesse Salinas

It's no secret: Most people, given a choice, would not move to a nursing home. Surveys have shown that 89 percent of Americans 50 and older want to live in their own homes as long as they can.While independence may become more challenging with age, a little assistance can go a long way in keeping people safely in their own homes. Alabama's Medicaid program should make this a priority in its spending for long-term care.Unfortunately, it hasn't been a priority, which is bad news not only for older Alabamians, but for Alabama taxpayers as well.The state's Medicaid program picks up most of the tab for Alabamians in nursing homes. This level of care generally costs three times as much as care provided in private homes and communities. Shifting more dollars to home-based and community services would not only be better for older Alabamians but for the state's bottom line.This year, Alabama Gov. Robert Bentley and state lawmakers undertook ambitious reforms to ensure better, more cost-effective care for Alabamians who receive other kinds of Medicaid services. But state leaders purposely put off any changes to long-term care. This important and very costly piece of the Medicaid puzzle will be evaluated on its own between now and 2015.AARP Alabama considers this a well-timed opportunity to improve the choices available to many Alabamians who need ongoing help to manage their health conditions and personal care. Medicaid should strive to provide the assistance that people need to maintain their dignity and personal preference and keep them in the homes and communities they love.Alabama has made some moves in the right direction. An initiative known as “Money Follows the Person” is supposed to help hundreds of people in nursing homes return to community living. AARP Alabama is one of a number of organizations that have begun meeting this summer to try to get this effort off the ground. But this is only a beginning if we are to get Alabama's Medicaid program where it needs to be. As it stands, our Medicaid program is picking up the tab for two-thirds of Alabamians in nursing homes at a cost of $900 million a year. But it provides extremely limited funding for services that can keep people out of nursing homes. Only 15 percent of Medicaid long-term care spending goes to services other than nursing homes. Our provision of services in homes and communities has consistently ranked among the worst in the country. Without more investment in alternative long-term care services, Alabamians will continue to be robbed of their quality of life and prematurely steered to institutionalization. And we, as a state, will pay a financial price.In 2008, the Medicaid expenditure per nursing home resident in Alabama was $32,322. For home and community services, the cost per Medicaid recipient was $9,704. For those needing only home-health services, the Medicaid expenditure per person was only $3,708.That is a huge difference, and one that is consistently noted around the country. In reviewing 38 studies of various state programs, AARP found a consistent cost advantage in long-term care services provided outside of nursing homes.Establishing a better mix of services must be a priority across the country as our population ages and requires more long-term services. It's especially critical in Alabama. Our people rank high in disease-related disabilities, high in poverty and low in the purchase of long-term care insurance — all of which bodes poorly for Medicaid.Providing more sensible care at a more sensible price was the goal this year when Alabama's leaders drafted and passed reforms targeting the rest of the Medicaid program. The goal should be no different as state leaders turn their attention to long-term care.To be clear, nursing homes must remain part of the equation for those who need 24-hour institutional care and have no other alternatives. Alabamians who need that level of care are fortunate to have a choice of quality nursing facilities.But similar choices should be available for those who want to remain at home — and could do so if provided services that cost considerably less than a nursing home.As Medicaid reform moves to the next phase, please join AARP Alabama in advocating for a coordinated long-term care system that offers consumers the choices they want — and at a price the taxpayers can afford.

Jesse Salinas is the state director of AARP Alabama, which has more than 450,000 members. Readers can email him at jsalinas@aarp.org.

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